Full Text MH-92-10

SHORT-TERM GRANTS FOR TRAINING MEDICAL STUDENTS IN THE DIAGNOSIS AND
TREATMENT OF DEPRESSIVE DISORDERS

NIH GUIDE, Volume 21, Number 7, February 21, 1992

RFA:  MH-92-10

P.T. 44

Keywords: 
  Biomedical Research Training 
  Depression 
  Diagnosis, Medical 
  Psychotherapy 


National Institute of Mental Health

Letter of Intent Receipt Date:  May 4, 1992
Application Receipt Date:  May 19, 1992

PURPOSE

As part of the Depression Awareness, Recognition, and Treatment (D/ART)
program, the National Institute of Mental Health (NIMH) seeks
applications from medical schools to develop and implement training of
pre-doctoral medical students in the diagnosis and treatment of
clinical depression according to a basic curriculum presented in this
Request for Application (RFA).  Support is available for the detailed
development of this curriculum, its implementation, and evaluation of
its educational effectiveness and impact.  The goal of the training is
to prepare medical students to deal with depressive disorders
(including major depression and bipolar disorder) as these disorders
appear in medical settings.  It is not designed to provide specialty
training for psychiatric residents.

HEALTHY PEOPLE

The Public Health Service (PHS) urges applicants to submit work plans
that address specific objectives of "Healthy People 2000" (see
objectives 6.13, 6.7).  Potential applicants may obtain a copy of
"Healthy People 2000" (Full Report:  Stock Number 017-001-00474-0) or
"Healthy People 2000" (Summary Report:  Stock Number 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC  20402-9325 (Telephone 202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by accredited schools of medicine and
osteopathy.  There is special interest in applications submitted by
departments of family medicine, internal medicine, obstetrics and
gynecology, and other nonpsychiatric specialties.

MECHANISM OF SUPPORT

This RFA will use the NIH Continuing Education Grant (T15).
Responsibility for the planning, direction, and execution of the
proposed project will be solely that of the applicants.

Terms and Conditions of Support

Period of Support:  The period of support is one year.

Average Size of Award:  It is expected that up to 10 awards will be
made, not to exceed $15,000 total (direct and indirect) costs per
award.  Funds made available under this grant may not be used to
supplement existing training or other support for such training.

Direct Costs:  Direct cost items are allowable for teaching costs
associated with this program including personnel, consultants,
materials, supplies, reproduction and printing costs, rental equipment,
minor equipment items, and other items that are directly related to the
proposed training program and are otherwise unavailable from the
institution.  Funds are not available for tuition and other subsidies
of medical students.  Funds may be used only for those expenses that
are directly related and necessary to carry out the project and must be
expended in conformance with DHHS cost principles, the Public Health
Service Grants Policy Statement, and conditions set forth in the RFA.

FUNDS AVAILABLE

It is expected that up to 10 awards will be made, each award not to
exceed $15,000 total (direct and indirect) costs per award.  Funds made
available under these grants may not be used to supplement existing
training or other support for such training.  The period of support is
one year.

Direct Costs:  Direct cost items are allowable for teaching costs
associated with this program.  They include personnel, consultants,
materials, supplies, reproduction and printing costs, rental equipment,
minor equipment items, and other items that are directly related to the
proposed training program and are otherwise unavailable from the
institution.  Funds are not available for tuition or other subsidies of
medical students.  Funds may be used only for those expenses that are
directly related and necessary to carry out the project and must be
expended in conformance with DHHS cost principles, the Public Health
Service Grants Policy Statement, and conditions set forth in this
document.  Regulations at 42 CFR Part 242a and Title 45 CFR Part 74 and
92 generic requirements concerning the administration of grants, are
applicable to these awards.

OBJECTIVES

Serious depressive disorders are a major public health problem in the
United States.  Because of the existence of effective psychological and
pharmacological treatments, which are often used in combination, most
people with depressive disorders can be successfully treated.  Evidence
suggests, however, that clinical depression is all too frequently
poorly recognized and underdiagnosed, with resulting undertreatment.
Although more than half of all clinically depressed patients are
initially seen in the general medical system, their symptoms are
frequently not diagnosed as a depressive syndrome and, thus, they are
not likely to receive the proper treatment.

The NIMH has developed the D/ART program to provide the most up-to-date
research knowledge to the general public, primary care providers, and
mental health specialists.

This grant program is responsive to the need for addressing the special
issues relating to the diagnosis and treatment of clinical depression
in a medical setting and to the need for training greater numbers of
primary care physicians at early stages of their professional
development.

STUDY POPULATIONS

SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH
POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL
RESEARCH STUDY POPULATIONS

In compliance with ADAMHA policy, ADAMHA grants and cooperative
agreements are required to include both women and minorities in study
populations, unless compelling scientific or other justification for
not including either women or minorities is provided.  All clinical
programs supported by ADAMHA are required to comply with this policy.

LETTER OF INTENT

It is suggested that those who anticipate applying send a letter of
intent to Harold Goldstein, Ph.D. (see INQUIRIES).  This letter of
intent is not binding, nor is it a necessary requirement, but the
information that it contains is helpful in planning for the review of
applications.  Letters of intent are to be received by May 4, 1992.
The letter of intent should include a descriptive title of the proposed
research, the name, address, and telephone number of the Principal
Investigator, the identities of other key personnel and participating
institutions, and the number and title of the RFA in response to which
the application may be submitted.

APPLICATION PROCEDURES

Applicants are to use the grant application kit PHS 398 (revised 9/91)
available from the Prevention Research Branch, Room 10-85, Parklawn
Building, 5600 Fishers Lane, Rockville, MD 20857; telephone (301)
443-4140.

To identify this application as a response to an RFA, check 'yes' on
line 2 page one of the PHS 398 form.  Also enter in item 2 the number
and title of this RFA, MH-92-10, Short-Term Grants for Training Medical
Students in the Diagnosis and Treatment of Depressive Disorders.  THE
RFA LABEL FOUND ON THE PHS 398 KIT MUST BE AFFIXED TO THE BOTTOM OF THE
FACE PAGE OF THE ORIGINAL COMPLETED APPLICATION FORM.  FAILURE TO USE
THIS LABEL COULD RESULT IN DELAYED PROCESSING OF THE APPLICATION SUCH
THAT IT MAY NOT REACH THE REVIEW COMMITTEE IN TIME FOR REVIEW.

Applications must be complete and contain all information needed for
initial and Advisory Council review.  No addenda will be accepted later
unless specifically requested by the Clinical Training Review
Administrator of the review committee.  No site visits will be made.

The applicant must include a project abstract that may not exceed two
single-spaced typewritten pages.  The narrative section of the
application may not exceed 25 pages; appendices may not be used
inappropriately to expand the narrative section.  Applications
exceeding this limitation will be returned to the applicant.
Applications submitted after the receipt date will be returned to the
applicant without review.

The original and four copies of the application must be submitted to:

Division of Research Grants
National Institutes of Health
5333 Westbard Avenue, Room 240
Bethesda, MD  20892**

One additional copy of the application must be submitted directly to:

NIMH Division of Extramural Activities,
Parklawn Building, Room 9C-02
5600 Fishers Lane
Rockville, MD  20857
Attention:  Clinical Training Review Administrator

Applications Characteristics

The applicant should provide:

o  a description of the applying entity, its relevant personnel, and
its training resources

o  a conceptualization of the training program, including its goals and
objectives

o  a detailed description of the proposed training program, including
the curriculum which must include, but need not be limited to the
following elements:

1) Epidemiology and Overview of Depression, including issues of
prevalence and incidence, drawing data from the NIMH Epidemiological
Catchment Area Study; risk factors; disability of clinical depression
relative to chronic medical illness; etiology; and accessibility to
medical treatment of clinical depression

2) Diagnosis and Assessment, including the major categories of
depression in DSM-III R (or subsequent revisions); overview of major
screening instruments for depression; impact of patient and physician
attitudes on diagnosis (and treatment); and determining severity of
depression

3) Depression within a Medical Setting, including disability from
depression; depression presenting with somatic symptoms, depression
comorbid with alcohol and substance abuse, depression secondary to
medical disorder; medication-induced depression; the primary
physician's role in diagnosis and treatment of clinical depression;
issues of relapse, recurrence and chronicity; referral and
relationships with other practitioners; and dealing with suicidality

4) Biological Treatments of Depression, including pharmacologic
treatments, their indications for use, relative efficacy and side
effects, and use in combination; ECT, light therapy, sleep deprivation

5) Psychosocial Aspects of Depression, including the psychosocial
context in which clinical depression occurs; the impact on the family;
the role and effectiveness of short-term psychotherapies (specifically
cognitive and interpersonal therapy); the relative effectiveness of
psychosocial therapies; and the use of pharmacological and psychosocial
treatments in combination

6) Special Issues, including depression in the elderly, adolescents,
the chronically ill, and other groups of concern.

The applicant should also provide:

o  for each component of the curriculum, a description of the content
to be addressed, the teaching materials to be  used, the proposed
faculty, the time frames to be allotted to each training module, and
the teaching methods to be used

o  a detailed description of how the curriculum will be implemented

o  the proposed number and level of students to be trained

o  a plan to evaluate the effectiveness of the program

REVIEW CONSIDERATIONS

Review Procedures

A dual review system is used to ensure knowledgeable, objective review
of the quality of applications.  Initial peer review for scientific,
educational, and/or technical merit is by groups of non-Federal experts
called Initial Review Groups.  Final review is by the National Advisory
Mental Health Council.

Review Criteria

Each grant application is evaluated on its own merits and will be
reviewed according to the following criteria:

o  experience in education on mental disorder issues

o  compliance with the requested application characteristics

o  appropriateness and feasibility of the content, methods, and
organization of the project to specified project goals and objectives

o  quality of the proposed program evaluation

o  quality of the resources of the applying organization

o  qualifications of the program director and other staff

o  number and range of students to be trained, especially minorities
and women

Receipt and Review Schedule

                              National Advisory
Receipt of       Initial      Mental Health       Earliest
Application      Review       Council Review      Start Date

May 19, 1992     Jul 1992    Sep 1992             Sep 1992

AWARD CRITERIA

The responsibility for award decisions on applications recommended by
the National Advisory Mental Health Council lies solely with authorized
NIMH program staff.  The basic criteria to be used in making award
decisions will be the quality of the proposed project as determined
during the review process and the availability of funds.

INQUIRIES

For further information regarding administrative details, contact:

Harold Goldstein, Ph.D.
Director of Training, D/ART Program
Prevention Research Branch
Division of Clinical Research
National Institute of Mental Health
Parklawn Building, Room 10-85
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-4140

For information regarding grants management issues, contact:

Stephen J. Hudak
Chief, Grants Management Section
Grants Management Branch
National Institute of Mental Health
Parklawn Building, Room 7C-26
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-4456

The mailing address for both of the above is:

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance
No. 93.244.  Applications will be accepted under the authority of
Section 303 of the Public Health Service Act (42 U.S.C. 242a); 42 CFR
Part 64.  This program is not subject to the intergovernmental review
requirements of Executive Order 12372 or review by a Health Systems
Agency.

.

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